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European Society of Radiology: Sports imaging is the main theme of IDoR 2019. In most countries, this is not a specialty in itself, but a focus within musculoskeletal radiology. In your country, is there a special focus on sports imaging within radiology training or special courses for interested radiologists?

Wenjian Xu: Yes, there is a special focus on sports imaging within continuing education training or courses that are organised by the Chinese Society of Radiology and different university hospitals across the country.


ESR: Please describe your regular working environment (hospital, private practice). Does sports-related imaging take up all, most, or only part of your regular work schedule?

WX: I work at Qingdao University Hospital, and sports-related imaging diagnoses take up a substantial part of my daily work.


ESR: Based on your experience, which sports produce the most injuries that require medical imaging? Have you seen any changes in this regard during your career? What areas/types of injuries provide the greatest challenge to radiologists?

WX: Knee and ankle injuries during football and basketball practice require medical imaging. Most cases can be diagnosed via plain radiography, but more complex cases require performing a magnetic resonance imaging (MRI) examination. The biggest challenge to radiologists may be having to diagnose tendon, ligaments, muscle and cartilage injuries.


ESR: Please give a detailed overview of the sports injuries with which you are most familiar and their respective modalities.

WX: I am most familiar with MRI examinations of acute and chronic injuries of cartilage.


ESR: What diseases associated with sporting activity can be detected with imaging? Can you provide examples?

WX: To name a few: fracture and joint dislocation, fatigue fracture, tendon and ligament injuries or tear, contusion and laceration of brain, liver, spleen, kidney.


ESR: Radiologists are part of a team; for sports imaging this likely consists of surgeons, orthopaedists, cardiologists and/or neurologists. How would you define the role of the radiologist within this team, and how would you describe the cooperation between radiologists, surgeons, and other physicians?

WX: Radiologists play the most important role in diagnosis before treatment and in treatment effectiveness follow-up. They provide evidence for surgeons or orthopaedists to determine the most appropriate treatment. Multidetector computed tomography (MDCT) is a nice modality for cooperation between radiologists, surgeons, and other physicians.


ESR: The role of the radiologist in determining diagnoses with sports imaging is obvious; how much involvement is there regarding treatment and follow-up?

WX: Diagnoses and suggestions from radiologists using sports imaging should be the most important input before treatment and follow-up.


ESR: Radiology is effective in identifying and treating sports-related injuries and diseases, but can it also be used to prevent them? Can the information provided by medical imaging be used to enhance the performance of athletes?

WX: Yes, radiology can be used to pre-empt injuries in professional athletes and the general population who likes to practise sports. The information from medical imaging could prevent some sports injuries, from light to worse, from happening.


ESR: Many elite sports centres use cutting-edge medical imaging equipment and attract talented radiologists to operate it. Are you involved with such centres? How can the knowledge acquired in this setting be used to benefit all patients?

WX: I am not involved in such centres. Maybe the radiologists can acquire knowledge from continuing education and courses given through local, national and international conferences held by radiology societies or other academic institutions, and skills disseminated during special commercial training.


ESR: The demand for imaging studies has been rising steadily over the past decades, placing strain on healthcare budgets. Has the demand also increased in sports medicine? What can be done to better justify imaging requests and make the most of available resources?

WX: Yes, the demand for sports imaging and generally sports medicine has increased in China, especially after the Olympic Games in Beijing in 2008. A lot of people like to exercise every day, for example in basketball, football, marathon, walking, and so on. Many healthcare centres and private imaging centres have recently been built across the country, but there is still a lack of radiologists in public hospitals, with a large number of patients who need imaging services. Imaging centres and Internet-based diagnostic centres would be an option to take care of more patients.


ESR: Athletes are more prone to injuries that require medical imaging. How much greater is their risk of developing diseases related to frequent exposure to radiation and what can be done to limit the negative impacts from overexposure?

WX: Lead protection against radiation must be provided in examinations that use ionising radiation. CT examination must be carried out with low radiation dose, and MRI should be used more widely.


European Society of Radiology: Sports imaging also applies to sports-related injuries of the brain. In case you are familiar with this, please also answer the following questions:


ESR: Which sports have the highest risk of inducing brain injuries?

WX: I would say boxing, football, riding, wrestling and high-speed sports like automotive racing.


ESR: What imaging modalities do you use with traumatic brain injury specifically in athletes?

WX: CT and MRI are the modalities I use in these patients.


ESR: How have advances in brain imaging allowed you to predict patient outcomes more accurately?

WX: We can use some new imaging modalities to make quantitative evaluation on brain injuries, for example, DCE-MR, SWI, DKI, IVIM, and so on.

Prof. Wenjian Xu is Professor of Radiology and Chairman of the Department of Radiology at the Affiliated Hospital of Qingdao University. He is a renowned expert in musculoskeletal imaging in China. His main research interests are musculoskeletal imaging, especially in the field of bone and joint tumour imaging. Prof. Xu has authored or co-authored more than 160 peer-reviewed publications and more than ten books and chapters published; and he has given numerous invited lectures, tutorials and refresher courses at national and international meetings. From 2009 to 2015 he was chairman of the musculoskeletal imaging board of the Chinese Society of Radiology (CSR).

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